Instrument #18: Questionnaires for Participants in Focus Group with Hispanic Population Focus

PACT – Father Questionnaire, Hispanic Fatherhood Study OMB #: 0970-0403

EXPIRATION: XX/XX/201X

Participant ID # ______________________________

Parents and Children Together (PACT) Evaluation

INSTRUMENT (18)

QUESTIONNAIRES

(FOR PROGRAM PARTICIPANTS)

Parents and children together (PACT)

Hispanic Father Questionnaire

Participant ID#: _________________

Data Collector#:__________________

Date: ______________________________

MONTH DAY YEAR

The [PREFILL RF PROGRAM NAME] program is part of the Parents and Children Together (PACT) study, a national study being conducted by the U.S. Department of Health and Human Services. The study is building knowledge about the effectiveness of Responsible Fatherhood grant programs and is seeking to describe grantee programs to support replication and improvement. The Department of Health and Human Services asked a research team from Mathematica to assist with the study.

This survey asks questions to fathers involved in [PREFILL RF/HM PROGRAM NAME]. The survey should take no more than 20 minutes to complete. Your participation in this survey is important and will help us understand more about participants in fatherhood programs. Your responses will be kept private and used only for research purposes. No individual names will be reported.

Participation in the survey is completely voluntary and you may choose to skip any question.

If you have any questions about the survey, please do not hesitate to contact Mathematica. You can reach Mathematica by calling 1-866-XXX-XXXX or e-mailing xxxxxxx@mathematica-mpr.com.

Thank you for completing this survey.

1. FATHER DEMOGRAPHIC INFORMATION

1. What is your date of birth ?____________

2. How old were you when you first became a father? ________

3. Where were you born?________________

1. (If foreign born) How old were you when you came to the United States?____________

4. Where was your mother born? __________________

1. Where was your mother’s mother born? _______________

2. Where was your mother’s father born? _______________

5. Where was your father born? ___________________

1. Where was your father’s mother born? _______________

2. Where was your father’s father born? _______________

6. How many years of school have you completed? ___________ years

Less than6 years

Less than 9 years Some high school (did not graduate)

High School diploma/GED Some university

College Degree Graduate degree

This collection of information is voluntary and will be used to learn about [RF PROGRAM NAME]. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to [Contact Name]; [Contact Address]; Attn: OMB-PRA (0970-0403).

7. How many years of school were completed in the U.S.? ___________ years

Less than6 years

Less than 9 years Some high school (did not graduate)

High School diploma/GED Some university

College Degree Graduate degree

8. Are you employed?

Yes 01

No 00

If YES:

1. How many hours per week do you work? ______

2. How long have you had this job? __________

9. Now or within the last year have you taken any classes or completed training through other programs?

Yes 01

No 00

If YES: What kind of class?

English Class

Vocational programs like construction or auto mechanic

Other ____________ (specify)

10. How many children do you have? ________How many of them live in the United States?____

11. Do all of your children who are in the U.S. live with you?

Yes 01

No 00

If NO: How many live with you?: ____________________________

B. CULTURAL IDENTITY – THE MEXICAN AMERICAN CULTURAL VALUES SCALE

Interviewer: The next statements are about what people may think or believe. Remember, there are no right or wrong answers. Tell me how much you believe that . . .

	Not at All	A Little	Some what	Very Much	Completely
1. Parents should teach their children that the family always comes first.	1	2	3	4	5
2. Children should be taught that it is their duty to care for their parents when their parents get old.	1	2	3	4	5
3. Children should always do things to make their parents happy.	1	2	3	4	5
4. No matter what, children should always treat their parents with respect.	1	2	3	4	5
5. People should learn how to take care of themselves and not depend on others.	1	2	3	4	5
6. Family provides a sense of security because they will always be there for you.	1	2	3	4	5
7. Children should respect adult relatives as if they were parents.	1	2	3	4	5
8. If a relative is having a hard time financially, one should help them out if possible.	1	2	3	4	5
9. When it comes to important decisions, the family should ask for advice from close relatives.	1	2	3	4	5
10. Men should earn most of the money for the family so women can stay home and take care of the children and the home.	1	2	3	4	5
11. One must be ready to compete with others to get ahead.	1	2	3	4	5
12. Children should never question their parents’ decisions.	1	2	3	4	5
13. The most important thing parents can teach their children is to be independent from others.	1	2	3	4	5
14. Families need to watch over and protect teenage girls more than teenage boys.	1	2	3	4	5
15. It is always important to be united as a family.	1	2	3	4	5
16. A person should share their home with relatives if they need a place to stay.	1	2	3	4	5
17. Children should be on their best behavior when visiting the homes of friends or relatives.	1	2	3	4	5
18. Parents should encourage children to do everything better than others.	1	2	3	4	5
19. Children should always honor their parents and never say bad things about them.	1	2	3	4	5
20. As children get older their parents should allow them to make their own decisions.	1	2	3	4	5
21. It is important to have close relationships with aunts/uncles, grandparents, and cousins.	1	2	3	4	5
22. Older kids should take care of and be role models for their younger brothers and sisters.	1	2	3	4	5
23. Children should be taught to always be good because they represent the family.	1	2	3	4	5
24. Children should follow their parents’ rules, even if they think the rules are unfair.	1	2	3	4	5
25. It is important for the man to have more power in the family than the woman.	1	2	3	4	5
26. Personal achievements are the most important things in life.	1	2	3	4	5
27. When there are problems in life, a person can only count on him or herself.	1	2	3	4	5
28. Holidays and celebrations are important because the whole family comes together.	1	2	3	4	5
29. Parents should be willing to make great sacrifices to make sure their children have a better life.	1	2	3	4	5
30. A person should always think about their family when making important decisions.	1	2	3	4	5
31. It is important for children to understand that their parents should have the final say when decisions are made in the family.	1	2	3	4	5
32. Parents should teach their children to compete to win.	1	2	3	4	5
33. Mothers are the main people responsible for raising children.	1	2	3	4	5
34. Parents should encourage children to solve their own problems.	1	2	3	4	5
35. It is important for family members to show their love and affection to one another.	1	2	3	4	5
36. It is important to work hard and do one’s best because this work reflects on the family.	1	2	3	4	5
37. Children should always be polite when speaking to any adult.	1	2	3	4	5
38. A wife should always support her husband’s decisions, even if she does not agree with him.	1	2	3	4	5

C. ACCULTURATION RATING SCALE FOR MEXICAN AMERICANS, ARSMA II

Interviewer: Now I’m going to ask you some questions about some American and Latino behaviors and how often you participate in each. Answer each question by selecting the number between 1 and 5 that best applies.

	Not at All	Very Little/ Not Much	Moderately	Much/ Very Often	Extremely Often/ Almost Always
1. I speak Spanish.	1	2	3	4	5
2.    I speak English.	1	2	3	4	5
3.    I enjoy speaking Spanish.	1	2	3	4	5
4.    I associate with Americans.	1	2	3	4	5
5.    I associate with (country of origin) and/or (country of origin)-Americans.	1	2	3	4	5
6.    I enjoy listening to Spanish language music.	1	2	3	4	5
7.    I enjoy listening to English language music.	1	2	3	4	5
8.    I enjoy Spanish language TV.	1	2	3	4	5
9.    I enjoy English language TV.	1	2	3	4	5
10. I enjoy English language movies.	1	2	3	4	5
11. I enjoy Spanish language movies.	1	2	3	4	5
12. I enjoy reading (e.g., books in Spanish).	1	2	3	4	5
13. I enjoy reading (e.g., books in English).	1	2	3	4	5
14. I write (e.g., letters or e-mails in Spanish).	1	2	3	4	5
15. I write (e.g., letters or e-mails in English).	1	2	3	4	5
16. My thinking is done in the English language.	1	2	3	4	5
17. My thinking is done in the Spanish language.	1	2	3	4	5
18. My contact with (country of origin) has been:	1	2	3	4	5
19. My contact with the USA has been.	1	2	3	4	5
20. My father identifies or identified himself as (country of origin)	1	2	3	4	5
21. My mother identifies or identified herself as a (country of origin)	1	2	3	4	5
22. My friends, while I was growing up, were of. (country of origin) origin.	1	2	3	4	5
23. My friends, while I was growing up, were of American origin.	1	2	3	4	5
24. My family cooks (country of origin)foods.	1	2	3	4	5
25. My friends now are of American origin.	1	2	3	4	5
26. My friends now are of (country of origin) origin.	1	2	3	4	5
27. I like to identify myself as an Anglo American.	1	2	3	4	5
28. I like to identify myself as a (country of origin)-American.	1	2	3	4	5
29. I like to identify myself as a (country of origin).	1	2	3	4	5
30. I like to identify myself as an American.	1	2	3	4	5

D. RELIGION

 I would now like to ask some questions about your involvement with social groups and organizations. 

1. Which religion, if any, do you identify with? ____________

  01 = Catholic 08 = Buddhist

02 = Protestant 09 = Hindu

03 = Santeria 10 = Wicca

04 = Mormon 11 = Atheist

05 = Jehovah's Witness 12 = None

06 = Jewish 13 = Other: Specify: _______________

07 = Muslim/Islamic

2. How often do you go to religious services or take part in related activities                           

   (e.g., choir practice, fellowship meetings, retreats, bible-study)? _________________

 

1. Never   

2.  Once or twice a year     

3.  Less than once a month

4.  About once a month      

5.  Several times a month   

6.  About once a week       

7.  Several times a week    

8.  Daily                                                                                                                                    

 

3. How important is religion to you? _________________                                                     

 

1.  Not important

2.  Somewhat important

3.  Very important                                                         

Thank you.

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